HF 2169 (LSB 5840YH (3) 87)

HOUSE FILE 2169

BY  KAUFMANN

A BILL FOR

An Act providing for midwife licensure, providing for fees, and making penalties applicable.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 147.1, subsections 3 and 6, Code 2018, are amended to read as follows:
   3.  “Licensed” or “certified”, when applied to a physician and surgeon, podiatric physician, osteopathic physician and surgeon, physician assistant, psychologist, chiropractor, nurse, dentist, dental hygienist, dental assistant, optometrist, speech pathologist, audiologist, pharmacist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, orthotist, prosthetist, pedorthist, respiratory care practitioner, practitioner of cosmetology arts and sciences, practitioner of barbering, funeral director, dietitian, marital and family therapist, mental health counselor, respiratory care and polysomnography practitioner, polysomnographic technologist, social worker, massage therapist, midwife, athletic trainer, acupuncturist, nursing home administrator, hearing aid specialist, or sign language interpreter or transliterator means a person licensed under this subtitle.
   6.  “Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery, practice as a physician assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting, occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and sciences, barbering, mortuary science, marital and family therapy, mental health counseling, polysomnography, social work, dietetics, massage therapy, midwifery, athletic training, acupuncture, nursing home administration, practice as a hearing aid specialist, sign language interpreting or transliterating, orthotics, prosthetics, or pedorthics.
    Sec. 2.  Section 147.13, Code 2018, is amended by adding the following new subsection:
   NEW SUBSECTION.  25.  For midwifery, the board of midwifery.
    Sec. 3.  Section 147.14, subsection 1, Code 2018, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  x.  For midwifery, a total of seven members, four members who are licensed midwives under chapter 148H; one member who is licensed under chapter 148, is a practicing family physician, and has professional experience consulting for and collaborating with direct-entry midwives; and two members who are not licensed midwives or licensed health care providers who have received direct-entry midwifery services and who shall represent the general public.
    Sec. 4.  Section 147.74, Code 2018, is amended by adding the following new subsection:
   NEW SUBSECTION.  26.  A midwife licensed under chapter 148H may use the words “licensed midwife” or the initials “L.M.” after the person’s name.
    Sec. 5.  NEW SECTION.  148H.1  Midwifery licensure —— legislative findings and intent.
   The general assembly recognizes the need for a person to have the freedom to choose the manner, cost, and setting for giving birth. The general assembly finds that access to prenatal care and delivery services is limited by the inadequate number of providers of such services and that the practice of midwifery may help to reduce this shortage. The general assembly also recognizes the need for the safe and effective delivery of newborn babies and the health, safety, and welfare of their mothers in the delivery process. The general assembly, in the interest of public health, promotes the regulation of the practice of midwifery in Iowa for the purpose of protecting the health and welfare of women and infants. The general assembly recognizes that midwifery is a profession in its own right and that it is not the practice of medicine or nursing.
    Sec. 6.  NEW SECTION.  148H.2  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Board” means the board of midwifery created pursuant to chapter 147.
   2.  “Licensed midwife” means a person who is licensed to practice midwifery as provided in this chapter and has obtained national certification from the North American registry of midwives or a successor organization.
   3.  “Midwife” means a person who is trained to give the necessary care and advice to a woman during pregnancy, labor, and the post-birth period, to conduct normal deliveries on the midwife’s own responsibility, and to care for the newly born infant, and who is able to recognize the warning signs of abnormal conditions requiring referral to or collaboration with a physician.
   4.  “Midwifery” means the practice of attending to a woman experiencing a low-risk pregnancy during pregnancy, labor, and the post-birth period with the informed consent of the woman, and the provision of comprehensive care of the pregnant woman during the antepartum phase, intrapartum phase, and postpartum phase, and the application of emergency care when necessary.
   5.  “Out-of-hospital” means any facility, institution, or place which is not an ambulatory surgical center or a hospital, such as a birth center as defined in section 135.61 or a private home.
    Sec. 7.  NEW SECTION.  148H.3  Licensure —— licensed midwifery.
   1.  Except as provided in section 148H.7, subsection 1, beginning July 1, 2018, every person practicing as a licensed midwife in this state shall be licensed pursuant to this chapter. The board shall adopt rules pursuant to chapters 17A, 147, and 272C establishing procedures for the licensure of new and practicing midwives.
   2.  Prior to obtaining licensure, an applicant shall successfully pass an examination prescribed and approved by the board by rule demonstrating competencies in at least all of the following areas:  risk assessment and management; prenatal care; management of normal labor, birth, and postpartum; newborn care up to six weeks; and adult cardiopulmonary resuscitation and newborn resuscitation.
   3.  The applicant shall hold a certified professional midwife credential issued by the North American registry of midwives or any other nationally accredited credential as specified by the board. If an applicant has been subject to prior revocation of a license to practice medicine or nursing, the applicant shall not be eligible for licensure under this chapter, except as determined by the board.
   4.  The board may request, at the applicant’s expense, that the department of public safety perform a criminal history check and the department of human services perform child and dependent adult abuse record checks of the applicant. If an applicant has a criminal record or a record of founded child or dependent adult abuse, the board shall perform an evaluation to determine whether the record warrants denial of licensure.
    Sec. 8.  NEW SECTION.  148H.4  Use of title —— penalty.
   A person shall not use the title “licensed midwife”, describe or imply that the person is a licensed midwife, or represent the person as a licensed midwife unless the person is licensed under this chapter or is licensed as a nurse-midwife under chapter 152.
    Sec. 9.  NEW SECTION.  148H.5  Rules.
   1.  The board shall:
   a.  Adopt rules relating to standards for professional conduct of persons licensed under this chapter.
   b.  Adopt rules consistent with this chapter and with chapters 17A, 147, and 272C which are necessary for the performance of the board’s duties.
   c.  Act on matters concerning licensure and the processes of applying for, granting, suspending, imposing supervisory or probationary conditions upon, reinstating, and revoking a license.
   d.  Administer the provisions of this chapter requiring documentation required to demonstrate competence as a midwife, and the processing of applications for licenses and license renewal.
   e.  Develop continuing education requirements as a condition of license renewal.
   f.  Evaluate requirements for licensure in other states to determine if reciprocity may be granted.
   g.  Establish and collect licensure fees as provided in section 147.80 and retain fees as provided in section 147.82.
   h.  Establish procedures for the issuance, renewal, and revocation or suspension of a license under this chapter.
   i.  Maintain a registry of licensed midwives and statistics on the practice of midwifery utilizing vital statistics data.
   2.  In developing rules, the board may consult with persons knowledgeable regarding the prenatal and postpartum birth process, particularly those possessing experience with out-of-hospital births, including but not limited to persons licensed under chapter 148, certified professional midwives, advanced registered nurse practitioners who are certified nurse-midwives, and women who have given birth in an out-of-hospital setting. In developing rules relating to the practice of midwifery, the board shall reflect the knowledge and skills identified by the North American registry of midwives’ current job description for the profession and the standards of practice of midwifery established by the national association of certified professional midwives or a successor organization.
   3.  Rules relating to the practice of midwifery shall be consistent with the North American registry of midwives’ current job description for the profession and the standards of practice of midwifery established by the national association of certified professional midwives or a successor organization, and shall not expand the scope of practice of midwifery established by the national association of certified professional midwives or a successor organization.
    Sec. 10.  NEW SECTION.  148H.6  Client disclosure.
   Prior to accepting a patient for midwifery care, a licensed midwife shall provide information to the patient indicating all of the following:
   1.  Evidence that the care provider is a licensed midwife meeting the requirements of this chapter.
   2.  Whether the licensed midwife has malpractice liability insurance coverage and the policy limits of such coverage.
   3.  The midwife’s educational background and relevant experience, including experience in various birth settings.
   4.  The nature, scope, and location of the care to be given, including the possibility of and the guidelines for consultation, referral, or transfer of the patient to a hospital from an out-of-hospital setting.
    Sec. 11.  NEW SECTION.  148H.7  Exceptions.
   1.  This chapter does not prevent qualified members of other professions including but not limited to individuals licensed under chapter 148 or 152 from providing services consistent with the nature of the practice of midwifery.
   2.  This chapter does not prevent or prohibit a student midwife from performing tasks related to the practice of midwifery under the supervision of a licensed midwife, a certified nurse-midwife, or a licensed physician during completion of the licensure process.
   3.  The practice of midwifery in this state prior to July 1, 2018, shall not constitute grounds for disciplinary action by the board. The board may issue a license to a person who has practiced midwifery in this state prior to that date upon that person’s application and compliance with the provisions of this chapter and the rules adopted pursuant to this chapter.
    Sec. 12.  NEW SECTION.  148H.8  Requirements for licensure —— temporary license.
   Beginning July 1, 2018, an individual who does not meet the requirements for licensure by examination pursuant to section 148H.3 may apply for a one-year temporary license, the qualifications for which shall be determined by the board by rule. Renewal of the temporary license shall be determined by the board. The board may revoke a temporary license if it determines that the temporary licensee has violated standards established by rule.
    Sec. 13.  Section 272C.1, subsection 6, Code 2018, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  ah.  The board of midwifery, created pursuant to chapter 147.
    Sec. 14.  Section 272C.4, subsection 6, Code 2018, is amended to read as follows:
   6.  Define by rule acts or omissions that are grounds for revocation or suspension of a license under section 100D.5, 105.22, 147.55, 148.6, 148B.7, 148H.5, 152.10, 153.34, 154A.24, 169.13, 455B.219, 542.10, 542B.21, 543B.29, 544A.13, 544B.15, or 602.3203 or chapter 151 or 155, as applicable, and to define by rule acts or omissions that constitute negligence, careless acts, or omissions within the meaning of section 272C.3, subsection 2, paragraph “b”, which licensees are required to report to the board pursuant to section 272C.9, subsection 2.
    Sec. 15.  INITIAL APPOINTMENTS.
   1.  Notwithstanding any provision to the contrary in this Act, the initial midwife appointees to the board of midwifery created pursuant to this Act shall fulfill the national certification requirements of the North American registry of midwives or a successor organization.
   2.  One of the initial midwife appointments to the board shall be appointed for a one-year term, one shall be appointed for a two-year term, and one shall be appointed for a three-year term. The member who is licensed under chapter 148 shall be appointed for a two-year term, and the members representing the general public shall each be appointed to a three-year term.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill creates new Code chapter 148H that provides for the licensure of midwives beginning July 1, 2018. A midwife, as defined by the bill, provides comprehensive maternity care to low-risk women during the antepartum, intrapartum, or postpartum period.
   The bill provides for the establishment of a seven-member board of midwifery consisting of four members who are midwives, one physician, and two members who represent the general public. The bill provides for fees to fund the board and provides penalties for violation of the licensure requirement; those penalties are set out for all health-related boards in Code chapters 147 and 272C. Code section 147.86 provides that it is a serious misdemeanor to violate a provision of the licensing laws.
   The board is similar in composition and responsibilities to other health-related licensing boards.
   The bill provides that a midwife practicing prior to the effective date of the bill is not required to take an examination for licensure.